Bariatric Surgery After 60 is Safe, Says Study

With commentary by Diego Camacho, MD, director of minimally invasive and endoscopic services at Montefiore Medical Center and assistant professor of surgery at Albert Einstein College of Medicine, New York.

Weight loss surgery in patients age 60 and over is safe and effective, according to a new study that evaluated 83 older patients who underwent two popular procedures.

Just as in younger patients, the surgery can not only help with weight loss, the researchers say, but also help to improve or eliminate weight-related problems such as high blood pressure and type 2 diabetes.

"Patients who are above age 60 have similar results as any other patients below age 60," says study researcher Diego Camacho, MD, director of minimally invasive and endoscopic services at Montefiore Medical Center and assistant professor of surgery at Albert Einstein College of Medicine, New York.

The patients, on average, were age 63, and were at an average pre-surgery weight of 269 pounds. They had about 120 pounds of excess body weight, on average. While more than 90% had high blood pressure, about 64% had diabetes and more than half had high cholesterol. Sleep apnea affected 35% and asthma, 30%.

At one year, the average excess weight loss was 65%. When the researchers compared the weight loss and other results with the general population, they found they were similar. Patients had either the laparoscopic sleeve gastrectomy or the Roux-en-Y gastric bypass, which Camacho says are the two most commonly done bariatric surgeries in the U.S.

Fewer post-surgical complications

In the past, many older patients were reluctant to undergo the bariatric procedures, Dr. Camacho says, due to the perceived risk of complications, such as infections and other problems.

However, in the past decade, Dr. Camacho says, surgeons have become more adept at the procedure. Weight loss is substantial, and with the weight loss has come a reduction in weight-related health problems as well. "We have been demonstrating that we can take care of a lot of medical problems," he says. "We can control or almost eliminate most of the [weight-related] medical problems, such as diabetes, high blood pressure, sleep apnea."

For instance, in study published in 2014, researchers evaluated 18 published studies and found that bariatric surgery did reduce weight-related problems. If body mass index (BMI) was reduced by 5 after surgery (such as from 40 to 35), the risk of diabetes declined by 33%, high blood pressure by 27% and high cholesterol by 20%.

Still, Dr. Camacho says, the decision to perform bariatric surgery in those age 60 and above must be done on a case-by-case basis. Not everyone may be a candidate, despite the overall good outcomes. For instance, someone who has had multiple abdominal surgeries may not be an ideal candidate for the bariatric procedures.

Bariatric surgery over 60: perspectives

The study results are not surprising to EndocrineWeb's Medical Advisory Board Member Scott Cunneen, MD, director of bariatric surgery at Cedars-Sinai Medical Center. He reviewed the findings.

The study was small, but the results reflect what physicians have been doing for years, he says—operating on patients who are good candidates regardless of age. "What this [study] basically says is, 'Just because you are 60 does not mean you cannot benefit significantly from these operations.'''

When Dr. Cunneen considers an older adult for the surgery, he assesses what he calls their physiological, rather than chronological, age. "You test how much reserve the body has, how broken down the body is," he says. Those tests include evaluating the heart, lungs and kidneys, he says.

Years ago, many doctors originally saw age 55 as the cut-off for bariatric surgeries. But techniques have vastly improved, and these days, ''the risk-profile for these weight loss surgeries are about as safe as having your gall bladder out," Dr. Cunneen says.

"At age 60, when the average length of life is 85, there are a lot of meaningful years left," he says. Not only can most older adults expect weight loss from the surgeries, he says, but they can also expect their diabetes, high blood pressure and other health issued to improve or resolve.

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